proximal tibiofibular joint

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The superior tibiofibular joint is a synovial joint between the superior aspects of the tibia and fibula and is one of the multiple sites of cartilaginous and fibrous articulation carrying the name of the tibiofibular joint.

Gross anatomy

Articulation
  • fibula: flat facet of fibular head
  • tibia: posterolateral aspect of the lateral tibial condyle
  • forms a plane-type synovial joint
Attachments
  • a tense joint capsule surrounds the joint and attaches to the tibia and fibula at the margin of the articular surface
  • anterior and posterior proximal tibiofibular ligaments strengthen the joint capsule that runs in a superomedial direction from the head of the fibula to the tibial condyle
  • additional support provided by the biceps femoris insertion onto the fibular head and by the lateral collateral ligament
Relations
  • popliteus tendon runs posterior to joint
  • popliteus bursa separates popliteus tendon from lateral tibial condyle (communicates with the tibiofibular synovial cavity)
  • biceps femoris tendon inserts into the fibular head

Blood supply

  • branches of inferior lateral genicular and anterior tibial recurrent arteries

Innervation

  • branches of the common fibular nerve and the nerve to the popliteus

Variant anatomy

  • variable synovial communication between superior tibiofibular joint and the knee joint (10-60%) 

Function

  • reduction of rotational stress
  • prevention of lateral bending of the tibia
  • spreading axial loads when standing

Radiographic features

Subtle proximal dislocations can be missed on plain film imaging. Lateral films may best demonstrate joint incongruity. Comparison with the contralateral knee on CT or plain film may improve detection. A high index of suspicion is required, and MRI is an often utilized modality.

Related pathology

  • it is rare to have an isolated joint injury to the superior tibiofibular joint
  • more commonly occurs in conjunction with other ligamentous or osseous pathologies
  • in multi-ligamentous knee injuries, superior tibiofibular joint integrity is required to ensure the success of fibular head-based posterolateral corner knee reconstruction
  • a contributor to chronic lateral knee pain and fibular nerve palsy in missed injuries
Dislocation
  • occurs as a result of significant rotational/twisting stress applied to the knee
  • anterolateral dislocation most common: occurs secondary to ankle inversion and plantar flexion with resultant rotation of knee joint.
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